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Minimally Invasive Reoperative Valve Surgery in a Developing Country: a new Paradigm
Tamer Ayed1, Ayman Sabry1, Sherrif Orieby1, Walid Ragab1, Wael Mobkhet1, Mark Anderson2.
1Galaa Family Hospital, Cairo, Egypt, 2Einstein Healthcare Network, Philadelphia, PA, USA.

OBJECTIVE: Rheumatic heart disease remains prevalent in developing countries. Often patients are denied reoperation due to the historically high perioperative morbidity and mortality. We initiated a minimally invasive cardiac surgical program in Cairo, Egypt, in 2012. As a part of this effort, we encountered patients in need of re-operative valve surgery who were subsequently approached with an MIS technique. The objective of this report is to detail the outcomes of these patients and compare them to those having had a conventional sternotomy technique.
METHODS: All patients who underwent a reoperative MIS procedure had their charts retrospectively reviewed for individual characteristics with emphasis being placed on intra-operative details and post-operative outcomes. These patients were then compared to a similar group having had a conventional sternotomy approach.
RESULTS: 14 reoperative MIS patients were identified since the program was initiated (8 male, 6 female, mn age 54 +/-9 years). The procedures included 13 reoperative MVR and 1 MVR / AVR. 1 procedure was a 2nd reoperation. All procedures were completed via a small right lateral thoracotomy with peripheral cannulation. During this same period 15 conventional sternotomy cases were identified. The baseline demographics were similar. The cases included 6 MVR and 9 MVR / TVR. There were no intra or post operative (30d) deaths in the MIS group and 1 (6.5%) in the conventional group. There was 1 (6.5%) reoperation for bleeding in the conventional group and none in the MIS group. Mean CT drainage was 931 +/- 390 ml vs 690 +/- 280 ml in the conventional and MIS groups p=<.05. There were no other significant differences in terms of post op morbidity between groups. ICU and total LOS was less for the MIS group having a mean of 60 hours and 6 days versus 72 hours and 8 days for the conventional cases which trended towards significance.
CONCLUSIONS: Despite the increased complexity the less invasive cases trended towards having superior outcomes. Routinely utilizing an MIS approach should allow a greater number of challenging patients to undergo surgical intervention and represents a new paradigm for cardiac surgery in a developing country.

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